First Name
Last Name
Title
Company
Address
City
State	Zip
Work Phone
FAX
E-mail
How long have your been in business?
Formal Education	(High School, College, Graduate Degree). If college degree, list:
	What is the approximate size of the population in your area? City     County     Trade Area
	Describe the products and/or services you offer:
	What is the dollar amount of your gross sales for the last full calendar year?
	Do you rent or own your business building?  rent  own
	Monthly rent amount?  What does rent include?
	Business structure? Sole-proprietership Partnership S-Corp LLC Sole proprietorship, partnership, Subchapter S, LLC
	Does your business presently carry any debt? If yes list the type, terms, repayment length in terms, and total amount of the loan(s) Please list type of debt, interest rate, monthly payment and outstanding balance.
	Describe how most of your clients find out about your business
	Do you have a database of your clients?  yes  no   How many clients are in your database?
	Do you send a company newsletter to your clients?   yes  no  If yes, how often
	Do you have employees? If so, list the type of work each does, and the number of hours they typically work per week and wages paid.  Identify if a spouse or other family member is involved in your business.
	List 5 major business problems or concerns, and discuss what you hope to accomplish with your business in the next 18 months.?